“Ostomy formation is an intrusive surgical operation that results in the loss of an important body function. It may result in long-term consequences such as disturbed sleep and peristomal skin irritations, and enormous challenges for personal care. Ostomy formation has psychological and social consequences that can be complex and persistent. Predictors of adjustment to ostomy include success of ostomy self-care, satisfaction with body image, amount of social support, and time since surgery. Survivor competence related to ostomy care has been described as the most important predictor of positive adjustment to ostomies.”1
A drainable ostomy system is a type of pouch that can be reused. Unlike the closed ostomy pouch, this type has a feature for draining the accumulated discharge in the pouch without needing to discard it.
The drainable ostomy system mechanism includes the use of a tap closure, clip closure, velcro or other effective methods that secure the pouch against accidental draining or leakage.
Others do not have an incorporated closing mechanism and depend on a clamp that is applied separately. This system is ideal for patients who have frequent and high-volume discharge.
Using a closed system for such patients would be quite inconvenient because it would mean changing the pouch with higher frequency. This can lead to skin irritation and predispose the peristomal area to infection.
The importance of a healthy peristomal skin
“The peristomal skin plays an important role in the normal use of stoma appliance. Skin problems often reduce the base plates’ ability to attach. This may lead to leakage, which can be socially restricting or, in some cases, even debilitating. The integrity of the peristomal skin is therefore of the utmost importance to the patients. Peristomal skin problems are thought to be common; some studies have reported frequency of 60%, while other studies report lower frequencies. Often, a skin problem can result in a vicious circle where a skin problem causes failure of the adhesive, which in turn gives rice to leakage, which can lead to more recalcitrant skin problems. […] Many different skin problems have been described. These include fecal dermatitis, mechanical dermatitis, folliculitis, psoriasis, allergic contact dermatitis, PPG and other rather uncommon conditions. […]
The major functions of the skin include protection of inner tissues from injury, drying and foreign substances. Loss of skin integrity in the peristomal area may lead to skin breakdown and thereby, to skin problem. Loss of skin integrity may be related to several variables. The following classification of skin problems is suggested based on previous studies: (1) Chemical injury e.g. irritant dermatitis from the effects of effluent; (2) Mechanical destruction/trauma e.g. caused by stripping, tear or pressure; (3) Infectious conditions e.g. bacterial, fungal or viral infection; (4) Immunological reactions e.g. allergic contact dermatitis; (5) Disease-related conditions e.g. pyoderma gangrenosum (PG) or psoriasis.”2
Drainable ostomy systems are commonly used in patients who have had an ileostomy, upper colon resection or a urostomy. Patients practicing ostomy irrigation can also use drainable pouches.
An ileostomy or upper colon resection creates more discharge because, at this point, the stool is more fluid than solid. Further water absorption and reabsorption that help in stool solidification mainly take place after the ileum process.
Types of Drainable Ostomy Pouch Systems
- One-piece drainable pouch. In this type, the pouch and the skin barrier (also known as wafer or baseplate) of the system are one inseparable piece. The whole system is removed during pouch changing.
- Two-piece drainable ostomy systems. Here, the pouch and the wafer (flange, skin barrier) are two different parts. The pouch can be removed independently, while the flange can be left in place for up to 4 days before attaching a new one.
One piece and two piece pouches
“A one piece pouch consists of the flange which adheres to the skin and the pouch as one unit. Patients report the benefits of these type of products as including ease of use and always feeling clean after changing. A two piece pouch consists of two parts, a flange which adheres to the skin and can stay in place for up to five days, depending on its type, and a separate pouch which can be changed easily as often as necessary without removing the flange on the skin. A two piece system gives the patient flexibility by allowing them to change the pouch daily to obtain a new filter and clean clip without spending time removing the complete unit. The patient can change from a closed pouch to drainable pouch easily and two piece pouches are convenient for activities such as swimming or intimacy. Patients who have a co-existing skin condition are usually advised to use a two piece product to reduce the risk of skin damage.
Drainable and closed pouches
The type of pouch recommended for a patient is determined by the stoma output. Patients who have a colostomy with a formed output are advised to use a closed pouch. Patients with an ileostomy are advised to use a drainable pouch as it will be necessary to empty the pouch regularly during the day and possibly at night. Urostomy patients use specific urostomy pouches, which have a tap at the end to allow ease of emptying and which can attach to a two liter night drainage bag at night. These pouches also have an anti-reflux valve which prevents backflow of urine towards the stoma to reduce the risk of ascending infection. Some urostomy patients also use a leg bag to increase storage capacity and increase the time between toilet visits.”3
What are the advantages of a drainable ostomy system?
- Ideal for patients with high discharge output due to the nature of the operation or due to digestive or ostomy issues.
- Requires changing pouches with less frequency.
- It can be economical in the long-run since fewer pouches are used.
- Easier to drain before disposal.
- “Advantages of a two-piece system. You can see the stoma as you apply the wafer so it may be easier to get the wafer exactly where you want it. You can also change the pouch without changing the wafer. So, if you want to wear a smaller closed end pouch during the day and a larger drainable pouch at night, you can change pouch without changing the wafer.”4
What are the disadvantages of Drainable Ostomy Systems?
- Difficult to empty solid discharge.
- The draining outlet must be cleaned meticulously. Some patients have difficulties with this, or find it repugnant.
- The draining outlet closing mechanism can cause discomfort.
- Increased risk of the draining outlet closing mechanism to give way and spill the contents of the pouch.
Although drainable ostomy systems do not require frequent changing, it is important to know and identify potential problems that can occur around the stoma. Some of these are:
- Stool leakage behind the flange attachment. This is more likely to be missed in a two-piece drainable pouch. If this happens frequently, it can cause skin sores and discoloration. “Containment of effluent substances are a consistent problem for the patient with a stoma, with up to 50% experiencing leakage. Peristomal skin damage from effluent substances actually increases the risk of leakage, rendering the skin more vulnerable to further damage and creating a cycle of harm, where effluent substances damage the skin, making application more difficult. The nature of the effluent contained within the stoma means that the peristomal skin is particularly vulnerable to damage. When the raised pH levels and increased moisture of urine and feces come into contact with the skin, the result is maceration, which can begin to erode the epidermis. These effects are exacerbated in aging skin due to structural changes including
- Decreased sweat glands
- Reduced vascular function
- Thinning of the epidermal layer
- Reduced skin elasticity
- Slower healing
Leakage can also affect the confidence and quality of life of the patient, as what is often a hidden function is now at risk of being exposed due to odor.”5
- Skin irritation, inflammation, and stripping. Fungal or bacterial infection of the hair roots of the skin (folliculitis).
- Stomal bruises
Issues like these should be reported to your health caregiver for early intervention. This will help to prevent more serious ostomy and general health complications.
- “Intact peristomal skin is the cornerstone to promoting positive outcomes for patients with a stoma. While many patients will have to deal with problematic skin at some point, it should not be considered the acceptable norm as it can have profound impact on an individual’s optimal physical, psychological and social functioning. Good skin health means that pouch barriers can function reliably, which in turn leads to consistent stoma care. By placing the patient at the center of that care, delivered in a timely way and with a basis in robust evidence, the CNS remains key in championing these positive outcomes. This enables patients to concentrate their efforts on building their confidence and wellbeing freer from the concern of pouch failure, the embarrassment of leaks and the self-assurance in their products and technique they need to take their normal place in the world”6
Drainable ostomy systems can be used with other accessories designed to make the patient’s experience better. These include belts and special garments.
The system can also come with an incorporated charcoal filter that helps in the prevention of gas accumulation in the bag. These filters allow the gas to escape but not the odor.
(1) Sun, V., Grant, M., McMullen, C. K., Altschuler, A., Mohler, M. J., Hornbrook, M. C., … & Krouse, R. S. (2013). Surviving colorectal cancer: long-term, persistent ostomy-specific concerns and adaptations. Journal of wound, ostomy, and continence nursing: official publication of The Wound, Ostomy and Continence Nurses Society/WOCN, 40(1), 61. Available online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3536890/
(2) Nybaek, H., & Jemec, G. B. E. (2010). Skin problems in stoma patients. Journal of the European Academy of Dermatology and Venereology, 24(3), 249-257. Available online at https://www.bbraun.com/content/dam/catalog/bbraun/bbraunProductCatalog/S/AEM2015/en-01/b8/skin-problems-instomapatients.pdf.bb-.46430544/skin-problems-instomapatients.pdf
(3) Moore, S. The practice nurses guide to new stoma care products. Nursing in General Practice. Available online at https://www.lenus.ie/bitstream/handle/10147/582817/art6.pdf;jsessionid=23FAA9C0CDF17E291D0E7CF222582E20?sequence=1
(4) Wound Ostomy and Continence Nurses Society (2000). Teen Chat: You and Your Ostomy. Available online at https://www.ostomy.org/wp-content/uploads/2018/01/wocn_teen_chat_you_and_your_ostomy.pdf
(5) Stephen-Haynes, J. (2013). The importance of peristomal skin care in the community setting. J Community Nurs, 27(4), 73-4. Available online at https://www.jcn.co.uk/files/downloads/articles/09-2013-peristomal-skin-care.pdf
(6) Boyles, A., & Hunt, S. (2016). Care and management of a stoma: maintaining peristomal skin health. British Journal of Nursing, 25(17), S14-S21. Available online at https://www.bbraun.com/content/dam/catalog/bbraun/bbraunProductCatalog/S/AEM2015/en-01/b8/maintaining-peristomalskinhealth.pdf.bb-.01791862/maintaining-peristomalskinhealth.pdf